Clinical characteristics and prognosis analysis of TCF3-PBX1 fusion gene-positive childhood B-cell precursor acute lymphoblastic leukemia / 白血病·淋巴瘤

Objective:To investigate the clinical characteristics and prognostic factors of TCF3-PBX1 fusion gene-positive childhood B-cell precursor acute lymphoblastic leukemia (B-ALL).Methods:The clinical data of 1 287 newly diagnosed children with B-ALL who were admitted to five hospital in Fujian province (Fujian Medical University Union Hospital, the First Affiliated Hospital of Xiamen University, Zhangzhou Affiliated Hospital of Fujian Medical University, Quanzhou First Hospital Affiliated to Fujian Medical University, Nanping First Hospital of Fujian Province) from April 2011 to December 2020 were retrospectively analyzed. According to the results of TCF3-PBX1 fusion gene testing, all the patients were divided into TCF3-PBX1-positive group and TCF3-PBX1-negative group. The clinical characteristics, early treatment response [minimal residual disease (MRD) at middle stage and end of induction chemotherapy] and long-term efficacy [overall survival (OS) and event-free survival (EFS)] of the patients in both groups were compared. Kaplan-Meier method was used for survival analysis. The prognostic factors of TCF3-PBX1-positive B-ALL were analyzed by using Cox proportional hazards model. Among 83 children with TCF3-PBX1-positive B-ALL, the treatment regimens, risk stratification and efficacy evaluation of 62 cases were performed by using Chinese Children's Leukemia Group (CCLG)-ALL 2008 regimen and 21 cases were performed by using Chinese Children's Cancer Group (CCCG)-ALL 2015 regimen, and the efficacy and incidence of serious adverse events (SAE) between the two groups compared.Results:Among 1 287 B-ALL patients, 83 patients (6.4%) were TCF3-PBX1-positive. The proportion of patients with initial white blood cell count (WBC)≥50×10 9/L in the TCF3-PBX1-positive group was higher than that in the TCF3-PBX1-negative group, while the proportions of patients with MRD ≥1% on induction chemotherapy day 15 or day 19, and MRD ≥0.01% on induction chemotherapy day 33 or day 46 in the TCF3-PBX1-positive group were lower than those in the TCF3-PBX1-negative group (all P < 0.05). Univariate Cox regression analysis showed that MRD ≥1% on induction chemotherapy day 15 or day 19 and TCF3-PBX1 ≥0.01% on induction chemotherapy day 33 or day 46 were risk factors for OS and EFS (all P < 0.05). Multivariate analysis showed that MRD ≥1% on induction chemotherapy day 15 or day 19 was an independent risk factor for OS ( HR = 10.589, 95% CI 1.903-58.933, P = 0.007) and EFS ( HR = 10.218, 95% CI 2.429-42.980, P = 0.002). TCF3-PBX1≥0.01% on induction chemotherapy day 33 or day 46 was an independent risk factor for EFS ( HR = 6.058, 95% CI 1.463-25.087, P = 0.013) but not for OS ( HR = 3.550, 95% CI 0.736-17.121, P = 0.115). The 10-year EFS and OS rates of the TCF3-PBX1-positive group were 84.6% (95% CI 76.9%-93.1%) and 89.1% (95% CI 82.1%-96.6%), and the differences between the two groups were not statistically significant (both P > 0.05). Among 80 children who received standardized treatment, compared with children who were treated with CCLG-ALL 2008 regimen, the incidence of infection-related SAE was lower in children who were treated with CCCG-ALL 2015 regimen [0 (0/21) vs. 20.3% (12/59), χ2 = 5.22, P = 0.022], but there were no statistical differences in treatment-related mortality, relapse rate, EFS and OS between the two groups (all P > 0.05). Conclusions:Children with TCF3-PBX1-positive B-ALL have a good prognosis, and MRD≥1% at middle stage of induction chemotherapy and TCF3-PBX1≥0.01% at the end of induction chemotherapy may be influencing factors for poor prognosis. CCCG-ALL 2015 regimen can reduce infection-related SAE while achieving good efficacy.

Diagnostic value of different gradient diffusion-weighted imaging for prostate cancer / 中国基层医药

Objective:To investigate the value of diffusion-weighted imaging (DWI) quantitative parameters with different b values in the diagnosis of prostate cancer and its correlation with prostate cancer diagnosis to determine the optimal b values.Methods:Forty-one patients with pathologically confirmed prostate cancer who were admitted by Yuyao People's Hospital from May 2019 to April 2021 were included in this study. Forty-seven foci were selected to undergo 1.5T MR high-resolution T 2-weighted imaging (T 2WI) and DWI. Four different b values (800, 1 000, 1 500, 2 000 s/mm 2) were applied to DWI. The apparent diffusion coefficient (ADC) values and areas of tumor region were measured on different b-value ADC maps. Tumor signal intensity and area were measured on DWI. The same area in the same layer was selected as the reference area to calculate and analyze the signal intensity. Results:The ADC values of tumor area were 0.93 ± 0.21, 0.87 ± 0.19, 0.76 ± 0.17 and 0.68 ± 0.14 when b values were 800, 1 000, 1 500 and 2 000 s/mm 2, respectively, which were significantly different from the ADC values of the reference area (1.59 ± 0.26, 1.50 ± 0.27, 1.28 ± 0.25, and 1.08 ± 1.84, t = 13.53, 13.08, 11.79, 7.30, all P < 0.01). However, there was no significant difference in the signal intensity ratio (-0.26, -0.27, -0.25, -0.22) on the ADC maps of tumor area under different b values ( P = 0.52). The DWI signal intensities of tumor region were 68.2 ± 19.1, 59.5 ± 18.8, 47.9 ± 17.7, and 50.1 ± 11.5, respectively when b values were 800, 1 000, 1 500, and 2 000 s/mm 2, respectively, which were significantly different from the DWI signal intensities of reference area (49.1 ± 17.7, 38.7 ± 11.3, 25.3 ± 6.9, 19.6 ± 4.5, t = 5.02, 6.50, 9.43, 16.93, all P < 0.01). DWI signal intensity ratio of tumor region at the b value of 800 s/mm 2 was significantly different from that at the b value of 1 000, 1 500 and 2 000 s/mm 2 (0.16 vs. 0.21, 0.30, 0.33, t = 10.84, 23.27, 22.85, all P < 0.01). DWI signal intensity ratio at the b value of 1 000 s/mm 2 was significantly different from that at the b value of 1 500 and 2 000 s/mm 2 ( t = 12.34, 14.10, both P < 0.01). Conclusion:High b-value DWI ( b ≥ 1 500 s/mm 2) has a remarkable advantage in the diagnosis of prostate cancer over low b-value DWI.

Application value of MR sequence imaging in the diagnosis and classification of perianal abscess and anal fistula / 中国基层医药

Objective To explore the clinical value of magnetic resonance imaging( MRI) in the diagnosis and classification of perianal abscess and anal fistula.Methods Eighty patients with suspected perianal abscess and anal fistula were selected in Yuyao People＇s Hospital from May 2016 to December 2017.They were divided into general examination group and MRI group by random number table,with 40 cases in each group. The general examination group underwent ultrasound examination,and the MRI group underwent MRI examination.The detection rate of MRI examination for various types of perianal abscess and anal fistula was analyzed based on the results of operation. Results In the general examination group, the diagnostic accuracy of anal fistula supervisor, anal fistula internal orifice,perianal abscess and anal fistula branch were 65.0% (26/40),70.0% (28/40),57.5% (23/40) and 52.5% (21/40),respectively,which in the MRI group were 92.5% (37/40),77.5% (31/40),87.5% (35/40) and 95.0% (38/40),respectively.There were statistically significant differences in diagnostic accuracy of anal fistula supervisor, perianal abscess and anal fistula branch between the two groups ( χ2 =9.054,7.116,8.865, all P <0.05). The effective rate of operation in the MRI group was 67.5% (27/40),which was significantly higher than that in the general examination group [67.5% (27/40)],the difference was statistically significant(χ2 =9.935,P<0.01). Conclusion Using MRI to diagnose perianal abscess and anal fistula can accurately judge the number,involvement range,specific location and surrounding structure of the abscess and anal fistula,and has important value for clinical treatment and prognosis.

The diagnostic value of the early rheumatoid arthritis classification criteria and clinical efficacy of knee arthroscopic synovectomy for early RA / 中国基层医药

Objective To evaluate the diagnostic value of the early rheumatoid arthritis (RA) classification criteria for early RA and to assess the clinical efficacy of knee arthroscopic synovectomy for RA.Methods A total of 62 patients who had arthritic complaints with disease duration less than one year were treated with knee arthroscopic synovectomy.Patients were diagnosed as RA confirmed by changes of synoviomorphous under arthroscopy,synovial biopsy,immunological biochemical laboratory and MRI,and compared with the preoperative ERA diagnosis.The efficacy was assessed at the third months and more than 12 months after operation,including Health Assessment Questionnaire (HAQ),Lysholm score,laboratory parameters of erythrocyte sedi-mentation rate (ESR) and C-reactive protein (CRP).Results The sensitivity and specificity in the early RA classification criteria for RA diagnosis were 81.58％ and 91.67％.38 patients diagnosed as RA and the remaining 24 patients were significantly improved of HAQ,Lysholm score,ESR,CRP compared with preoperation,showed statistical difference (P ＜ 0.01).There were still statistical differences between the follow-up results of the group of patients with RA in different period after operation (P ＜ 0.01).Conclusion The early RA classification criteria is worthy of clinical application,because it has the advantages of simple,practical,and is beneficial to early diagnosis of RA.The early RA patients should be treated with knee arthroscopic synovectomy as far as possible.It can improve not only the knee function,but also the general symptoms,and it can interrupt the RA pathological process,effective maintain curative effect after operation.

Case-control based study between polymorphisms in the adiponectin gene and polycystic ovary syndrome / 中华妇产科杂志

Objective To investigate the frequeney of four single nucleotide polymorphism (SNP) sites (rs17300539, rs12495941, rs2241766 and rs1501299) of adiponectin gene (ADIPOQ) and to elucidate its role in the pathogenesis of polycystic ovary syndrome (PCOS).Methods A total of 207 women with PCOS and 192 controls were recruited.Four ml whole-blood samples were collected in tubes containing ethylene diamine tetraacetic acid (EDTA) by peripheral venous puncture.Genomic DNA was extracted using a QIAamp DNA mini kit.Four SNP sites (rs17300539, rs12495941, rs2241766 and rs1501299) of ADIPOQ were amplified by PCR and then directly sequenced to screen variants.Results (1) The genotype frequencies of AA of rs17300539 in PCOS was significantly higher than controls [57.5％ (119/207) versus 48.4％ (93/192), P＜0.05].The genotype frequencies of AA of rs1501299 in PCOS was significantly lower than controls [4.8％ (10/207) versus 11.5％ (22/192), P＜0.05].While no significant differences were found in rs2241766 and rs12495941 (P＞0.05).(2) The allele A of rs17300539 [75.8％ (314/414)] and allele C frequeneies of rs1501299 [76.3％ (316/414)] in PCOS were significantly higher than controls [67.7％ (260/ 384), 69.0％ (265/384), respectively;all P＜0.05].While no significant differences were found in rs2241766 and rs12495941 (P＞0.05).(3) Further analysis we found rs17300539 AA genotypes had an increased risk for PCOS compared with GG genotype (OR=2.670, P=0.009), rs1501299 CC genotype had an increased risk for PCOS compared with AA genotypes (OR=2.756, P=0.012);and the difference remained significantly after adjustment for age, testosterone and body mass index (P＜0.05).Conclusions No signifi cant differences were observed in genotype and allele frequencies between PCOS and controls for rs2241766 and rs12495941.However, we observed an association between rs17300539, rs1501299 and PCOS.rs17300539 and rs1501299 of ADIPOQ perhaps are the susceptibility gene locus of PCOS.

Multi-segment transpedicle spinal fixation for thoracolumbar fractures with ankylosing spondylitis:one-year follow-up / 中国组织工程研究

BACKGROUND:Because of osteoporosis, short-segment transpedicular fixation or screw-rod system fixation is prone to screw loosening depending on its poor anti-pul-out strength in patients with thoracolumbar fracture with ankylosing spondylitis. OBJECTIVE:To probe the clinic outcomes of multi-segment transpedicle spinal fixation for thoracolumbar fractures with ankylosing spondylitis. METHODS:Eleven patients with ankylosing spondylitis combined with thoracolumbar fracture in the Fourth Department of Orthopedics, Meizhou Hospital, Sun Yat-sen University, China from January 2009 to December 2012 were selected. Al the patients underwent posterior reduction and multi-segment transpedicle spinal fixation, among whom, six cases were subjected to internal fixation through the pedicle of fractured vertebra. RESULTS AND CONCLUSION:Al of the 11 patients were fol owed up for 13 to 36 months. Solid bone healing was achieved in al of the patients, and there were no complications related to the internal fixation systems such as loosening or breakage. Three cases of spinal cord injury achieved Frankel’s class E from class C recovery. Lumbodorsal pain rate achieved 100%according to the Japanese Orthopaedic Association scoring. Results confirmed that it is effective to treat thoracolumbar fractures with ankylosing spondylitis by posterior reduction and multi-segment transpedicle spinal fixation. Strong internal fixation and fracture union can be achieved by operation.